September 29, 2015

The internet has changed nearly
every aspect of our lives. The way we communicate, shop, and learn has
fundamentally changed. Websites abound with information which can be accessed
nearly instantaneously. Social networking sites and instant messaging
applications allow us to connect with people worldwide with a simple click of
the mouse or tap on the screen. Although many social media tools were
originally developed for, well, socializing, many of them can be used for
professional and educational purposes as well. I was first introduced to the
idea of Twitter for professional education
during my first advanced pharmacy practice experience (APPE). My preceptor
(@PharmERToxGuy) along with a number of the medical residents and attending
physicians actively sent and received messages on Twitter. They used Twitter as
a means of sharing clinical pearls, staying up to date on literature, and
connecting to others in their specialty worldwide. I, in jest, joined Twitter
as my "final project.” Since then I have been surprised by what I’ve
learned. But the use of social media sites is not risk free, especially in
educational settings. It can compromise the authority of the teacher-learner
relationship and blur the lines between professional and personal life. In health
professional education, there’s the added risk of compromising patient
anonymity. Twitter use, as with most things, is all about the risk/benefit
ratio. How does one minimize these risks and maximize the quality learning
opportunities available through Twitter?

Twitter has been adopted in
various educational settings as a means to dialogue with and engage learners as
well as a forum for sharing knowledge.This
practice has been slowly adopted in health professional education. The first
paper regarding Twitter’s use in health professional education was published in
2009.1 Several reports have
been published since.Most are descriptive in nature. They address a
variety of uses including "Tweeting the Meeting", evidence based
tweeting, learner engagement, blog dissemination, and networking.1-6

With the increased use of social media, many journals have added social
media editors to their editorial team in an attempt to increase readership. The
Journal of Continuing Education in the Health Professions appointed
Alexander M. Djuricich, MD to this position in 2014. In an article he wrote
describing his position, he explained that one goals is "to connect with
the continuing education and continuous professional development community
beyond the traditional peer-reviewed publication format."2 Other
well-known journals including the Journal of the American Medical Association
(JAMA) and the British Medical Journal (BMJ) regularly send evidence-based
tweets (EBT) to their followers.2 These tweets generally contain a
brief description or pearl along with a link to the original source. The link provides
followers direct access to primary literature from an array of journals which
are relevant to practice. Learning who the right people, organizations, and
journals to follow is key to finding quality Tweets.Strategically employing hashtags is another tactic
to maximize learning.

“Tweeting the meeting” has increased substantially over the past few years
at national conferences. Many medically related conferences now have their own
hashtag(s) including the largest pharmacy conference, the ASHP Midyear Clinical
meeting (MCM). Audience members can interact with speakers, ask questions, make
comments, and archive information for retrieval after the meeting. At the ASHP
MCM in 2013, 31% of postings were related to specific educational sessions.3

The use of Twitter in conferences isn't limited to large, national
gatherings. Local conferences such as grand rounds and weekly resident
conferences have also created hashtags and taken to tweeting the meeting.6
This allows clinicians with similar interests in different geographic locations
to share experiences and improve their practice. In March 2012, a hospital in
Indiana started tweeting grand rounds. There were 613 tweets sent from 17
consecutive grand rounds presentations.4 Tweets came from users
physically attending as well as those following asynchronously. This breakdown
of geographical barriers engages learners and maximize learning opportunities.

There are a few simple tips to maximize your Twitter experience. The
quality of your Twitter feed is directly related to who you follow. Be
selective!Identifying experts in your
specialty area is key to increasing the quality of the Tweets you read. Even
when following the “right” people (the so called twitterati), it’s important to
maintain a skeptical eye. Remember, Tweets are not always evidence based and
they certainly aren’t peer reviewed literature. They are often opinions or über
brief summaries of primary literature or anecdotal reports. It is important to
read the literature and draw your own conclusions. If you disagree with the
Tweeter, respectfully respond and engage in a discussion. Just like face-to-face
dialog, the best learning often comes from professional differences of
opinion. But it’s important to remain professional. Don’t be a TrashTweeter! And don’t use your
professional title or credentials without first checking your institution’s
policies regarding social media use. Recently, the Royal Pharmacuetical Society
published a guidance document.7 Once you’ve built your Twitter
network and start meeting people at conferences, it can be difficult to keep
use strictly professional. If you want to use Twitter for social purposes too,
consider creating a separate personal account. This helps to keep a clearer
division between the two.

Twitter can be a great resource for connecting with experts in your field,
staying up to date on primary literature, and engaging at conferences. If you
are a twewbie, learning twettiquette
can help you navigate the Twitosphere. Getting started is easy. Fly on over,
create an account, and start reading what people have to say. You might be surprised
by what you learn.

[Editor's note:For more detailed
instructions on how to create a Twitter account and some recommended twitter
feeds for health professionals, visit Using
Twitter for Professional Development on the iForumRx.org website. Follow us at @iforumrx.]

September 28, 2015

by Zak Cerminara, PharmD; PGY2 Oncology Pharmacy Resident, University
of Maryland School of Pharmacy

I realize the irony of this essay
as I write it with only five hours left until I have to wake up. Personally I
struggle with the daily decision between staying up to work on a project or finishing
homework or catching up on the emails and going to bed at a reasonable time.
While I am sure that most people, me included, are aware that the lack of sleep
is not healthy for your body or mind, does everyone really understand how
detrimental sleep deprivation can be?

A lot of people are cognizant of
the fact that young adults should get seven to eight hours of sleep every
night, but how many people actually accomplish this? A Gallup survey in 2013
found that 59% of Americans get seven or more hours of sleep each night.This means that over 40% get less!And 14% of Americans say they get less than
five hours of sleep per night. This is a substantial difference when compared
to the original survey conducted in 1942. Back then 84% of Americans reported
getting seven or more hours of sleep each night with the average person getting almost eight hours per night. While you
might expect that people today willingly sleep fewer hours and are satisfied
with the amount of sleep they get, 43% of people in the 2013 survey said they
would be happier if they got more sleep.1

Knowing that there is this large
gap between the amount of sleep we get compared to what we should be getting is
one thing. But how does the lack of sleep impact our performance? Sleep is
important for our bodies — it's the time when our bodies repair and grow. But
sleep also important for our mental state, including memory and cognitive
function. During sleep our brains consolidate the memories and experiences from
the day — and this facilitates learning as we process the day’s events. Students may think that staying up to study
for a big exam will benefit them (e.g. spending additional time learning the
material) but, in actuality, they are doing themselves a disservice.

Sleep loss not only causes fatigue
and sleepiness but it also leads to neurocognitive and psychomotor performance
impairments. One meta-analysis found that sleep-deprived individuals performed
at a level comparable to the ninth percentile of those who had adequate sleep.2
Lack of sleep has been shown to impact the prefrontal cortex, which is
responsible for higher brain functions including memory, reasoning, and
language. One study found that shortening sleep duration lead to decreased
memory encoding and knowledge retention, suggesting that the hippocampus may be
affected.3

A study conducted with first-year college
students found that for every hour delay in sleep, the predicted GPA decreased
by 0.13 on a 4.0 scale. This study sought to determine favorable and negative
health related variables and their relation to GPA. The study found that the
variables that had the highest correlation to poor GPA were later weekday and
weekend wake up time as well as later weekday and weekend bedtimes.4
Another study compared the sleep habits of the lowest and highest quintile of
performers base on their GPA. They did not find any significant difference in
total hours of sleep between the two groups, but they did find that students
with the highest GPAs went to bed earlier and woke up earlier when compared to
students who performed less well academically.5

I know that some of you might be
saying: “I’m in [law / medical / pharmacy / graduate] school. There aren’t enough
hours in the day to get everything done. Plus, I think I am smart enough to
know if I were experiencing the detrimental effects of sleep deprivation on my
academic performance.” Actually, you probably don’t.

In a slightly barbaric study,
investigators examined the impact of sleep deprivation on performance.6
They found that after just one night of sleep deprivation, college students
(n=44) scored significantly lower on a cognitive task when compared to a group
of students who were not sleep deprived. Amazingly, the sleep deprived students
ranked their concentration, effort, and estimated performance significantly
higher than those students who were not sleep deprived.6 This
suggests that while you feel like you are performing well, you lack an
awareness of how detrimental sleep deprivation impacts your performance!

A recent study looked at the sleep
patterns of pharmacy students.7 Not surprisingly, the investigators
found that students who reported sleeping an average of 6 hours or less each
night were statistically more likely to report feeling tired when waking up and
throughout the day.Those who got less
sleep were also more likely to feel excessively sleepy during class and when studying
course materials. When looking at actual academic outcomes, comparing the grades
of those who slept more or less than an average number of hours during the week
was not statistically different. This finding mirrors previous studies. However,
it is important to note that most of the students in the study slept well under
the recommended number of hours each night, averaging about six hours of sleep per
night.Thus most of the students were
sleep deprived! The most compelling finding of this study was the relationship
between the number of hours slept the night before an exam and academic
performance. The authors found that those with a GPA less than 2.5 slept an
average of 4.60 hours the night before a test, while those with GPAs above 3.5
slept an average of 5.53 hours before the test.7 There is one
caveat. While one might assume that these students are studying when they stayed
up late the night before an exam, the author’s acknowledge they don’t know with
certainty what these students were actually doing.

So what can educators do to help learners
get more sleep? The most obvious solution is to make certain the amount of work
students are expected to do outside the classroom is reasonable. While homework
and outside projects are certainly beneficial to learners, paying attention to
the amount as well as the sequencing of assignments is key. Overburdening the
learner with a bunch of assignments all due the same week is a recipe for
disaster! Parsing out big assignments into small chunks helps learners stay on
task. Furthermore, ensuring that concepts are taught well during class sessions
(e.g. using active learning strategies) is another way educators can help. If learners
spend hours of time outside the classroom trying to relearn or memorize
concepts because they were poorly understood in class, it’s a waste of time. Using
audience response questions and working through practice problems in class can
help the teacher gauge student learning. Lastly, explicitly coaching students
about how to manage their time is another strategy – including encouraging learners
to get a good night’s sleep!

So the next time you are considering
staying up late to finish work, consider a few things: Could it wait until
tomorrow? What level of cognition does the work require? And is it worth
staying up to finish if there is a strong likelihood that you won’t perform as
well or may need to redo parts of it tomorrow? Maybe you should get a good
night’s of sleep instead.

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